Literacy remains a critical problem in the U.S. with nearly half of the adult population having some limitations in functional literacy. Likewise, health literacy, "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" is a serious concern. Nearly nine out of ten adults have difficulty using everyday health information from providers, retail outlets, and the media. Adding to the complexity of health care decision making is the increased popularity and availability of complementary and alternative therapies (CAM). Health care consumers, particularly those with chronic health conditions, make numerous decisions about health care and use a wide variety of self care health practices;decisions often made independent of providers. The Institute of Medicine (IOM) noted that there is very little research on how American consumers obtain, understand, and evaluate information about the various CAM therapies. Knowing consumers'reading and numeracy skills, as can be ascertained with currently available health literacy instruments, does not adequately evaluate their ability to make informed self management decisions in today's health care environment. The currently available instruments do not measure the broad range of cognitive skills needed for health literacy nor do they assess literacy demands on consumers within different health contexts such as CAM. The IOM cited a critical need for more rigorous work to develop appropriate, reliable, and valid measures of health literacy, and to study health literacy in a variety of health contexts. The overall goal of this study is to develop a psychometrically sound instrument to evaluate CAM health literacy. The MSU CAM Health Literacy Scale will focus on older adults, a population more likely to have a chronic illness and so use CAM. The specific aims of this study are to: a) refine the MSU CAM Health Literacy Scale, and b) conduct psychometric evaluation of the scale. The approach is based on DeVellis'guidelines for scale development. To date, steps 1-3 and part of step 4 of DeVellis'process have been completed. This application addresses the remaining steps which involve review of the scale by focus groups and a panel of experts, validation assessment, administration to a large development sample, exploratory and confirmatory factor analysis, and evaluation. The scale will be revised as needed following each step. The proposed study will contribute to a fuller understanding of health literacy as it relates to CAM and result in a first generation measure of CAM health literacy. This is the first known attempt to develop a measure of health literacy as it relates to CAM. It is anticipated that the scale will be efficacious to the research team's further studies to be focused on the effectiveness of interventions designed to enhance consumers'CAM knowledge and to promote informed use of CAM. Informed use of CAM can increase health and illness management options and encourage well-reasoned decision-making regarding self care. PUBLIC HEALTH RELEVANCE: The intent of this study is to continue development of the MSU CAM Health Literacy Scale. There are currently no existing instruments to assess how American consumers obtain, understand, and evaluate information about complementary health practices. Outcomes of this study, together with results of the team's prior work will contribute to the development and evaluation of an educational intervention to promote health literacy about CAM. Without adequate CAM health literacy, consumers may not know of all the appropriate health care choices, may fall victim to scams or unscrupulous sales practices, or ingest potentially harmful substances. It is anticipated that the scale being developed will have scientific and clinical application for assessing health literacy in other health care decision-making situations.